大腸MALTリンパ腫に対する抗生剤投与療法―自験例5例と文献報告例のまとめ

Effects of Antibiotic Administration on Colonic MALT Lymphoma

要旨　大腸原発MALTリンパ腫に対して抗生剤投与を行った自験例5例ならびに文献報告例10例を含めて，その治療効果について検討した．H. pylori除菌に準じた抗生剤投与により12例で病変が消失し，3例では縮小し抗生剤投与の有効性は明らかであった．病変が消失した10例の消失までの期間は平均116.5日であり，その後，再発は認めていない．浸潤深達度に関しては，未消失例が全例sm浸潤であったのに対し，消失例はmp以深の浸潤が5例あり，深達度は抗生剤投与の治療効果に影響しなかった．一方で，縮小にとどまった3例はいずれも病変が多発しておりまた平均年齢も消失例と比べ有意に高かった．今後，抗生剤投与後の長期経過や無効時の追加治療時期・治療法などの検討がさらに必要であるが，非侵襲的な治療として抗生剤投与は第一選択となりうるものと考えられた．

　We examined clinical effects on colonic MALT lymphoma after administration of antibiotics in five of our cases and 10 reported cases. After antibiotic administration using the same treatment as that used for H. pylori eradication, the lesion disappeared in 12 cases and regressed in 3 cases. Therefore, the efficacy of antibiotic therapy for treating colonic MALT lymphoma was established definitely. In the 10 cases where the lesion had disappeared, the period of time up to the dissappearance of the lesion was a mean of 116.5 days and no relapse was observed after this period. The depth of tumor invasion was evaluated by endoscopic ultrasonography. All of the unresponsive MALT lymphomas were located in the submucosal layer. On the other hand, five of the responsive MALT lymphomas had infiltlated into the muscular layer or deeper. The characteristic appearance of the 3 cases that were unresponsive was multiple lesions and the mean age of these patients was more advanced than the age of the responsive cases. It is suggested that antibiotic administration may be considered to be the first choice of treatment for colonic MALT lymphoma.